Image-guided temporal bone dissection course

Introduction: Temporal bone anatomy is complex and demands a profound anatomical knowledge. Association between surgery and imaging helps in the process of learning three-dimensional (3D) anatomy and surgical techniques. High definition temporal bone imaging can play an important role in dissection training. Objective: To describe a computed tomography (CT) image-guided temporal bone dissection course for surgical training in otolaryngology and to verify the satisfaction level of the students with the course. Methods: Descriptive research. The course took place at a research laboratory, with three experienced temporal bone surgeons. The participants were 12 otolaryngology residents. The laboratory has 7 modern workstations with microscope and monitors linked with a computerized video system. Cadaveric temporal bones were donated to the university. Imaging acquisition of the cadaveric temporal bones used in the course was performed in a multislice CT scanner. The CT images of cadaveric temporal bones were available with real-time access on the laboratory monitor's screens during dissections. Results: A total of 13 temporal bones were included for dissection. Students had the opportunity to view on the same screen, simultaneously, both the dissection video and the respective CT images of their temporal bone anatomical specimens. This allowed correlating surgical and imaging aspects of temporal bone anatomy. At the end of the course, participants answered a satisfaction survey. Conclusion: Considering imaging methods are routinely used during most otologic surgeries, detailed knowledge of CT imaging should be explored in conjunction with the temporal bone anatomical dissection

Electrocochleography for the assessment and monitoring residual hearing in cochlear implant candidates

INTRODUÇÃO: O aprimoramento tecnológico dos aparelhos de implante coclear aliado a técnicas cirúrgicas minimamente traumáticas têm permitido que pacientes com audição residual e com indicação de cirurgia sejam implantados com eletrodos convencionais com boas chances de preservação auditiva. A possibilidade de melhores resultados audiológicos nestes pacientes, após a cirurgia, tem tornado essencial a monitorização da audição residual e, por conseguinte, da função coclear, antes, durante e após a realização do implante. Desta forma, a eletrococleografia (EcoG) ganha destaque, por tratar-se de um método objetivo capaz de obter respostas elétricas da cóclea com boa amplitude de sinal tanto na orelha média, através da EcoG transtimpânica (EcoGTT), quanto na orelha interna, por meio da EcoG intracoclear (EcoGI). O objetivo deste estudo é analisar a viabilidade da eletrococleografia (EcoG) para avaliação e monitorização de adultos com audição residual e submetidos ao implante coclear. MÉTODO: As respostas da eletrococleografia transtimpânica (EcoGTT) a tone bursts com fases alternadas de 250, 500 e 1000 Hz foram registradas antes da cirurgia em 10 pacientes com audição residual na orelha definida para o implante. O procedimento cirúrgico, utilizando a técnica de soft surgery, foi realizado em todos os pacientes, e a eletrococleografia intracoclear (EcoGI) intraoperatória foi registrada durante e após a inserção do feixe de eletrodos na cóclea. As médias dos limiares de microfonismo coclear (MC) na EcoGTT e na EcoGI, nas frequência de 250, 500 e 1000Hz, foram relacionadas com as médias dos limiares da audiometria tonal, realizada antes e após 3 e 12 meses da cirurgia, nas mesmas frequências. RESULTADOS: Todos os pacientes apresentaram MC na EcoGTT pré-operatória. Uma média de 0,3 dB foi observada entre os limiares audiométricos e os limiares da EcoGTT no préoperatório. Uma perda auditiva média de 37,5 dB e 43 dB foram observadas após 3 meses e 12 meses de cirurgia, respectivamente, em comparação com limiares audiométricos tonais pré-operatórios. Uma média de 0,5 dB foi observada entre os limiares estimados na EcoGI intraoperatória e os limiares tonais audiométricos após 12 meses de cirurgia. CONCLUSÃO: A eletrococleografia (EcoG) mostrou-se eficiente para avaliar e monitorizar a audição residual em pacientes submetidos ao implante coclear, fornecendo importantes informações eletrofisiológicas da cóclea durante as diferentes etapas da cirurgiaINTRODUCTION: The technological improvement of the cochlear implant devices combined with minimally traumatic surgical techniques have allowed patients with residual hearing to be implanted with conventional electrode arrays with good chances of hearing preservation. The possibility of better audiological results in these patients after surgery has made essential to monitor residual hearing and, consequently, cochlear function, before, during and after implantation. The electrocochleography (EcochG) stands out as an objective method capable of obtaining electrical responses from the cochlea with good signal amplitude in the middle ear, through transtympanic EcochG (TTEcochG), and in the inner ear, through the intracochlear EcochG (ICEcochG). The aim of this study is to analyze the feasibility of electrocochleography (EcochG) to access and monitor residual hearing in patients who underwent cochlear implant surgery. METHODS: Transtympanic electrocochleography (TTEcochG) responses to tone bursts with alternating phases at 250, 500, and 1000 Hz were recorded before surgery in 10 patients with residual hearing in the ear to be implanted. The surgical procedure using the soft surgery technique was performed in all patients and intraoperative intracochlear electrocochleography (ICEcochG) was recorded during and after insertion of the electrode array into the cochlea. The mean of the cochlear microphonism (CM) thresholds from TTEcochG and ICEcochG at the frequencies of 250, 500 and 1000Hz were related to the mean of the pure tone audiometry thresholds (PTA), performed before and 3 and 12 months after surgery at the same frequencies. RESULTS: All patients showed CM responses during preoperative TTEcochG. A mean of 0.3 dB was observed between pre-op audiometric PTA and pre-op TTECochG thresholds. A mean hearing loss of 37.5 dB was observed at 3 months post-op and a mean of 43 dB hearing loss was observed at 12 months compared to preoperative audiograms. A mean of 0.5 dB was observed between intraop ICECochG thresholds and 12-month audiometric thresholds. Conclusion: The electrocochleography (EcochG) proved to be efficient to access and monitor residual hearing in patients who underwent cochlear implant surgery, providing important electrophysiological cochlear information during the different steps of the surger

Profissionalismo médico como competência formativa: evidências no currículo e nos significados atribuídos por alunos do internato em Saúde da Família

Profissionalismo médico (PM) compreende o exercício da medicina considerando ciência, consciência e excelência. Objetivou-se, neste artigo, descrever como o PM se apresenta no currículo médico e reconhecer o universo semântico dos internos de medicina sobre o tema. Trata-se de pesquisa qualitativa, do tipo estudo de caso, realizada mediante aplicação de questionário a 55 alunos do internato em Saúde da Família de um curso sediado no estado do Ceará, Brasil, e análise do projeto pedagógico do curso (PPC). O PPC foi explorado quanto aos domínios do PM; as palavras expressas pelos estudantes foram processadas pelo software IRaMuTeQ por análise prototípica e de similitude, com discussão à luz da Matriz de Competências do Profissionalismo Médico no Brasil. Competência cultural e compromisso com a competência técnica se destacaram, enquanto que os demais domínios foram identificados como incipientes. Os estudantes atribuíram significados de PM associados à ética (f=39; OME=2,1), à empatia (f=21; OME=2,4) e à responsabilidade (f=17; OME=2,3). O Profissionalismo Médico revelou-se fragmentado no currículo e refletiu universos semânticos em elaboração, elucidando a necessidade de estimular essa competência na formação dos graduandos

Image-guided Temporal Bone Dissection Course

Introduction Temporal bone anatomy is complex and demands a profound anatomical knowledge. Association between surgery and imaging helps in the process of learning three-dimensional (3D) anatomy and surgical techniques. High definition temporal bone imaging can play an important role in dissection training. Objective To describe a computed tomography (CT) image-guided temporal bone dissection course for surgical training in otolaryngology and to verify the satisfaction level of the students with the course. Methods Descriptive research. The course took place at a research laboratory, with three experienced temporal bone surgeons. The participants were 12 otolaryngology residents. The laboratory has 7 modern workstations with microscope and monitors linked with a computerized video system. Cadaveric temporal bones were donated to the university. Imaging acquisition of the cadaveric temporal bones used in the course was performed in a multislice CT scanner. The CT images of cadaveric temporal bones were available with real-time access on the laboratory monitor's screens during dissections. Results A total of 13 temporal bones were included for dissection. Students had the opportunity to view on the same screen, simultaneously, both the dissection video and the respective CT images of their temporal bone anatomical specimens. This allowed correlating surgical and imaging aspects of temporal bone anatomy. At the end of the course, participants answered a satisfaction survey. Conclusion Considering imaging methods are routinely used during most otologic surgeries, detailed knowledge of CT imaging should be explored in conjunction with the temporal bone anatomical dissection

Brazilian Flora 2020: Leveraging the power of a collaborative scientific network

International audienceThe shortage of reliable primary taxonomic data limits the description of biological taxa and the understanding of biodiversity patterns and processes, complicating biogeographical, ecological, and evolutionary studies. This deficit creates a significant taxonomic impediment to biodiversity research and conservation planning. The taxonomic impediment and the biodiversity crisis are widely recognized, highlighting the urgent need for reliable taxonomic data. Over the past decade, numerous countries worldwide have devoted considerable effort to Target 1 of the Global Strategy for Plant Conservation (GSPC), which called for the preparation of a working list of all known plant species by 2010 and an online world Flora by 2020. Brazil is a megadiverse country, home to more of the world's known plant species than any other country. Despite that, Flora Brasiliensis, concluded in 1906, was the last comprehensive treatment of the Brazilian flora. The lack of accurate estimates of the number of species of algae, fungi, and plants occurring in Brazil contributes to the prevailing taxonomic impediment and delays progress towards the GSPC targets. Over the past 12 years, a legion of taxonomists motivated to meet Target 1 of the GSPC, worked together to gather and integrate knowledge on the algal, plant, and fungal diversity of Brazil. Overall, a team of about 980 taxonomists joined efforts in a highly collaborative project that used cybertaxonomy to prepare an updated Flora of Brazil, showing the power of scientific collaboration to reach ambitious goals. This paper presents an overview of the Brazilian Flora 2020 and provides taxonomic and spatial updates on the algae, fungi, and plants found in one of the world's most biodiverse countries. We further identify collection gaps and summarize future goals that extend beyond 2020. Our results show that Brazil is home to 46,975 native species of algae, fungi, and plants, of which 19,669 are endemic to the country. The data compiled to date suggests that the Atlantic Rainforest might be the most diverse Brazilian domain for all plant groups except gymnosperms, which are most diverse in the Amazon. However, scientific knowledge of Brazilian diversity is still unequally distributed, with the Atlantic Rainforest and the Cerrado being the most intensively sampled and studied biomes in the country. In times of “scientific reductionism”, with botanical and mycological sciences suffering pervasive depreciation in recent decades, the first online Flora of Brazil 2020 significantly enhanced the quality and quantity of taxonomic data available for algae, fungi, and plants from Brazil. This project also made all the information freely available online, providing a firm foundation for future research and for the management, conservation, and sustainable use of the Brazilian funga and flora